- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,370.32 / $13,489.63
| Facility | | $1,412.54 | $5,370.32 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $11,748.98
| Facility | 22 | $2,691.53 | $2,691.53 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,511.38 / $16,218.10
| Facility | | $3,235.94 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,398.83 / $8,511.38
| Facility | | $398.11 | $2,398.83 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | 22 | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | AS | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,244.36 / $16,982.44
| Facility | | $2,398.83 | $7,244.36 | $16,982.44 |